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Organization
BROOKSIDE PEDIATRIC THERAPY LLC
Active
Organization
BROOKSIDE PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YASSER MANSOUR (CEO)
(313) 207-4645
Entity
Organization
Contact information
Practice address
39650 ORCHARD HILL PL, NOVI, MI 48375-5392
(248) 747-4263
Mailing address
39650 ORCHARD HILL PL, NOVI, MI 48375-5392
(248) 266-1188
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/06/2023
Last updated
10/07/2024
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